The Arduous Path Toward Equitable Access to Endocrinology Care

Abstract

Multiple factors contribute to the widening gap between supply and demand of endocrinology services. In addition to the inadequate growth of the workforce, the inefficient utilization of endocrinologists' expertise coupled with the rising prevalence of endocrine conditions has generated a crisis in access to specialty care. This mismatch is magnified in underserved communities and among certain racial/ethnic groups that carry a disproportionate burden of chronic diseases, like diabetes and osteoporosis, thus perpetuating the cycle of health disparities in vulnerable populations. Reorienting the framework of endocrine care toward more effective and equitable access will require comprehensive changes in operational processes, system-based policies, and in the diversity of our workforce. Specifically, the progressive transition to outcome-driven, team-based models of care can extend endocrinology services beyond the traditional boundaries of in-office referrals and promote job satisfaction. Further, the implementation of policies that directly tackle structural determinants of health is a prerequisite to a more precise and equitable deployment of specialty care. In this view, the recruitment and professional growth of clinicians underrepresented in medicine along the career ladder, including leadership roles, is a key conduit to revitalize our field and to innovate the delivery of endocrine care across all communities.

Keywords: care models; endocrinology access; health disparities; shortage of endocrinologists; underrepresented in medicine.

Figure 1.

Trends in endocrinology workforce and distribution of adult endocrinologists in the United States. A, Trends of endocrinologists primarily active in patient care (red) or other activities (research, teaching or administrative roles; orange), and first-year endocrinology fellows (blue) between 2007 and 2021. The patient care/predicted plot (black) represents the anticipated number of patient-focused physicians based on the number of fellows graduating in the previous year, assuming no changes in attrition. Note gap between the actual and predicted pool of active physicians between 2019 and 2021. Data are extracted from the Association of American Medical Colleges https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-specialty-2021 and National Residency Matching Program https://www.nrmp.org/match-data-analytics/fellowship-data-reports/. B, Breakdown of endocrinology workforce by self-identified race/ethnicity and sex in 2018. Data are extracted from the Association of American Medical Colleges https://www.aamc.org/data-reports/ workforce/data/table-12-practice-specialty-females-race/ethnicity-2018 and https://www.aamc.org/data-reports/workforce/data/table-13-practice-specialty-males-race/ethnicity-2018. C, Overlay of county distribution of adult endocrinologists by zip code and social vulnerability index (SVI). NPI data for endocrinologists was extracted from the National Plan and Provider Enumeration System (https://www.cms.gov/medicare/regulations-guidance/administrative-simplification/data-dissemination) and filtered by taxonomy code (207RE0101X). SVI map was extracted from https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html.